Low estradiol with no anastrozole use: Confused.

[johndoesmith]

60mg E3D 400 IU hCG E3D. I started TRT in may. So all of these are steady state and there have been no changes to my protocol at all.
I have no symptoms to speak of. I got these done out of curiosity and boredom. I've had low E2 before, and I have none of that.
Wtf labcorp? Hopefully I get the estradiol free lab back, because that tests total E2, and I believe it's a sensitive test as well.
My E2 was higher naturally...

I have never taken AI. No new supplements. No weight loss. No serious weight gain, maybe a few lbs since august or something.

Dr. Saya can you comment? I'm utterly perplexed if this isn't a lab error.

 

[BryanW]

Lab Nazi confirmed!!! I knew it lol. No disrespect intended, I think you do a lot of good over on reddit (and here).

 

[johndoesmith]

Lab Nazi confirmed!!! I knew it lol. No disrespect intended, I think you do a lot of good over on reddit (and here).

I know of no such person.

 

[CSI007]

That's crazy. I will follow this closely considering your numbers almost are exactly like mine. With E2 that low I would think you would be in a world of hurt.

 

[johndoesmith]

That's crazy. I will follow this closely considering your numbers almost are exactly like mine. With E2 that low I would think you would be in a world of hurt.

It has to be a lab error. It's the only explanation that makes sense.

My E2 has always been about total testosterone/30. Now it's total testosterone/262? Doesn't make any sense.

I just don't know how the standard test and sensitive compare for me specifically. I've seen it overestimate and underestimate E2 in guys when drawn at the same time.

I hope I get the "free estradiol and serum" back tomorrow. Knowing labcorp I probably won't.

 

[Dr Justin Saya MD]

Agree lab error makes the most sense at this point. Await the total/free estradiol results for confirmation. Lab errors, unfortunately, happen more often than many may think.

 

[johndoesmith]

Agree lab error makes the most sense at this point. Await the total/free estradiol results for confirmation. Lab errors, unfortunately, happen more often than many may think.

Heh, if that comes back with something even more confusing, I'm just going to give up haha.

The free estradiol test says "MS" so I assume it's similar to the LC/MS-MS sensitive assay?

I truly don't understand progesterone, I remember you explained that either low or high progesterone exacerbates E2's effect, right?

 

[Dr Justin Saya MD]

Heh, if that comes back with something even more confusing, I'm just going to give up haha.

The free estradiol test says "MS" so I assume it's similar to the LC/MS-MS sensitive assay?

I truly don't understand progesterone, I remember you explained that either low or high progesterone exacerbates E2's effect, right?

Yes, unless they have changed, the free estradiol should be the sensitive assay.

Per our previous discussions regarding the inexplicable reference change for progesterone at LabCorp, the current progesterone assay is (in my opinion) essentially uninterpretable. For this reason, I've now (effective this week) begun swapping out progesterone for SHBG on routine labs. A slight cost difference for patients (SHBG costs more), but certainly more clinically useful especially given the progesterone assay changes. Progesterone of 0.2 is perfectly normal (for SURE it is not high). For reference just yesterday EVERY SINGLE patient had a progesterone of 0.2 or higher...it is normal but falsely flagged as high due to the abnormally low change to the reference range.

 

[johndoesmith]

Yes, unless they have changed, the free estradiol should be the sensitive assay.

Per our previous discussions regarding the inexplicable reference change for progesterone at LabCorp, the current progesterone assay is (in my opinion) essentially uninterpretable. For this reason, I've now (effective this week) begun swapping out progesterone for SHBG on routine labs. A slight cost difference for patients (SHBG costs more), but certainly more clinically useful especially given the progesterone assay changes. Progesterone of 0.2 is perfectly normal (for SURE it is not high). For reference just yesterday EVERY SINGLE patient had a progesterone of 0.2 or higher...it is normal but falsely flagged as high due to the abnormally low change to the reference range.

That's good to know!

I wasn't concerned about progesterone being high, I remember our previous discussion and your frustration with patients being upset with the "high" result. I was just saying I don't understand progesterone's role, but that's something I'm going to have to research myself because it's probably too complicated for one person to explain.

Do you know if the range for progesterone being changed is reflective of labcorp using a different assay? Or did they just adjust the reference range based on results from their patients?

Hopefully that makes sense.

 

[Dr Justin Saya MD]

That's good to know!

I wasn't concerned about progesterone being high, I remember our previous discussion and your frustration with patients being upset with the "high" result. I was just saying I don't understand progesterone's role, but that's something I'm going to have to research myself because it's probably too complicated for one person to explain.

Do you know if the range for progesterone being changed is reflective of labcorp using a different assay? Or did they just adjust the reference range based on results from their patients?

Hopefully that makes sense.

Response I received from LabCorp regarding the change:

"Thank you for your inquiry into the male reference intervals for progesterone. The range was changed as a result of new progesterone reagent from Roche Diagnostics, the manufacturer of the reagent and the instrument upon which it is performed. The new reagent was developed to improve the specificity at the low end of the progesterone reference range. As a result of this improvement, the upper end of the male range was significantly lower than the previous range due to diminished interference from compounds that could slightly raise male progesterone levels. Hence, the previous range was slightly higher to compensate for such interference. The new range was established by Roche, as was the previous range, and is included in their FDA cleared package insert."

 

[Dr Justin Saya MD]

So the upper end of the reference range has been cut off and appears to be more sensitive at the lower end. With that said, however, the reference range is still clearly erroneous based on a standard patient population. Without exaggeration 95% or more of the lab reports have come in with a progesterone level greater than 0.1. Most have been in a 0.1 to 0.5 range based on hundreds of reports I've received since the reference range change.

There is an LC/MS send out lab for progesterone to endocrine sciences that is available, however it comes at a significantly higher cost.

 

[johndoesmith]

So the upper end of the reference range has been cut off and appears to be more sensitive at the lower end. With that said, however, the reference range is still clearly erroneous based on a standard patient population. Without exaggeration 95% or more of the lab reports have come in with a progesterone level greater than 0.1. Most have been in a 0.1 to 0.5 range based on hundreds of reports I've received since the reference range change.

There is an LC/MS send out lab for progesterone to endocrine sciences that is available, however it comes at a significantly higher cost.

Thank you! You always go above and beyond when asked a question, and not just with me, but anyone on this forum! I can honestly say that your participation on here is what led to me being a client.

I still don't understand how anyone can use that reference range, there's literally only 2 numbers that can ever be "in range". You're right, it's essentially useless, way to go labcorp!

 

[Dr Justin Saya MD]

Happy to be of assistance johndoesmith!

Your activity and assistance on this board is noticed and appreciated by all as well.

 

[johndoesmith]

It was a lab error. 28pg/mL E2 makes sense, and is usually about where I am.

Other than that, I ordered the other estrogens(total, estrone, standard E2, and free E2 and boy am I glad I ordered this one) just out of curiosity, so estrone being high isn't concerning me as I had no symptoms and still do not.

I imagine the estrone test isn't too accurate, nor is the total estrogens test, which would explain why "total" is lower than estrone. Oh well.

Do take note that my sensitive E2 is higher than the standard test, much like the test results I found and posted in my "inaccuracy of the standard assay" thread. You can't assume standard E2 always overestimates.

I know CRP causes it to OVERestimate, but what could possibly cause it to UNDERestimate other than just being a poor quality assay?

 

[Dr Justin Saya MD]

View attachment 3005


It was a lab error. 28pg/mL E2 makes sense, and is usually about where I am.

Other than that, I ordered the other estrogens(total, estrone, standard E2, and free E2 and boy am I glad I ordered this one) just out of curiosity, so estrone being high isn't concerning me as I had no symptoms and still do not.

I imagine the estrone test isn't too accurate, nor is the total estrogens test, which would explain why "total" is lower than estrone. Oh well.

Do take note that my sensitive E2 is higher than the standard test, much like the test results I found and posted in my "inaccuracy of the standard assay" thread. You can't assume standard E2 always overestimates.

I know CRP causes it to OVERestimate, but what could possibly cause it to UNDERestimate other than just being a poor quality assay?

Yes estrone is inaccurate (as well as total estrogens as you state) and of no concern due to this fact.

Agree, most ASSUME the standard estradiol OVERestimates estradiol levels compared to he sensitive assay, but I have seen many cases including yours of the exact opposite. It really just boils down to the standard assay being less accurate and less reliable, whether over or underestimating.

 

[johndoesmith]

Yes estrone is inaccurate (as well as total estrogens as you state) and of no concern due to this fact.

Agree, most ASSUME the standard estradiol OVERestimates estradiol levels compared to he sensitive assay, but I have seen many cases including yours of the exact opposite. It really just boils down to the standard assay being less accurate and less reliable, whether over or underestimating.

I appreciate your insight!

I wholeheartedly agree regarding the standard assay! I'm going to shamelessly self promote https://www.excelmale.com/forum/showthread.php?9253-Evidence-of-the-standard-E2-test-s-inaccuracy

 

[Vince Carter]

I know you're well versed at stability in your testing patterns, my first thought was lab error or a fluke test.

 

[johndoesmith]

I know you're well versed at stability in your testing patterns, my first thought was lab error or a fluke test.

Haha I'd be quite the hypocrite if I didn't maintain consistency! Plus I posted the full lab results, in order, with as much information as I possibly could remember.

So glad I got that "free estradiol" otherwise I'd be scratching my head, as labcorp didn't wanna rerun the sensitive E2 test. They said nothing was wrong. Their own test proves there was something wrong haha!